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Thread: Humeral Head Resurfacing w/Meniscal Allograft Glenoid Resurfacing

  1. #1

    Default Humeral Head Resurfacing w/Meniscal Allograft Glenoid Resurfacing

    AAPC: Back to School
    What do you think? 23929 compared to 23470 or 23472? I haven't been able to find a clear answer on this anywhere.

    ...at this point an anterior deltopectoral approach was performed. This was carried down through subcu tissue sharply. The deltopectoral approach was then taken through the deltoid muscle, which had a cuff of deltoid taken with the cephalic vein to protect this. The glenohumeral articulatioin was then opened by identifying the subscapularis and this was tekn up with cancellous chips of bone, carefully tagged and retracted. The biceps tendon was then divided at its bicipital groove. The tendon was allowed to retract slightly. The patient then had the humeral shaft externally rotated and center point was picked on the humeral head. Once this was selected the pin was driven into position and the humeral head was then sequentially reamed until a good, round, smooth surface was obtained. A tunnel was created to impact the humeral HemiCAP into place and once this was complete the humeral head was then retracted posteriorly to expose the glenoid.

    The glenoid then had meniscal allograft from the Musculofascial Foundation then selected. This was then excised from its bony block and was secured using two #2-0 FiberWire sutures. These were then passed through the posterior labrum through the glenohumeral articulation and sequentially these were used to draw the glenoid labral tissue to the posterior labrum. This was then repaired circumferentially using #2-0 FeiberWire sutures and once complete this was felt to be very stable. At this point the HemiCAP was then impacted into the humeral head until good adequate fit was obtained. Any surrounding osteophyte was then removed and subsequently the glenhumeral articulation was then reduced. At this point the biceps was then tenodesed into a keyhole onto the bicipital groove using an Arthrex Bio tenodesis set. The tendon was whipstitched in the end and then secured down using a Bio tenodesis screw. Once this was secured and tied the tenodesis sutures were then cut and the subscapularis was then repaired through tunnels on the lateral aspect of the bicipital groove using #2 FiberWire sutures. These were then tied down while the shoulder was held in neutral position and the rotator cuff interval was then repaired using #1 Vicryl in a figure of eight fashion. The deltopectoral groove was then closed after adequate irrigation using #1 running locking Vicryl and the subcu tissue using 2-0 Vicryl. The skin was then stapled, sterile dressing applied...

    Thanks for your help,

    Kara Hawes, CPC

  2. #2

    Default I need an answer to this one also, please!

    Regence denies 23929 for HemiCap procedure for Shoulder. I don't believe I should use 23470. Any one else have any advice on this one?

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